Progression of urinary protein excretion after kidney transplantation: A marker for poor long-term prognosis

1. To determine whether treatment with octreotide, a somatostatin analogue, may diminish or prevent long-term diabetic renal hypertrophy and nephropathy, uninephrectomized streptozotocin-diabetic rats maintained under moderate glycaemic control (∼300 mg/dl) were treated with either placebo (n = 10 rat/group) or octreotide for 14 weeks. Uninephrectomized non-diabetic rats given either placebo or octreotide served as controls. 2. Average body weight was diminished and kidney weight, daily urinary protein excretion, glomerular filtration rate and renal plasma flow were elevated in both diabetic groups relative to controls. 3. Administration of octreotide reduced average body weight and packed cell volume in non-diabetic and diabetic rats compared with their respective controls, but did not affect glomerular hyperfiltration or the increase in urinary protein excretion. 4. Histological examination at 14 weeks disclosed unequivocal glomerular hypertrophy and mild glomerular and tubulointerstitial lesions consistent with early diabetic renal alterations in all diabetic rats, but there was no independent effect of octreotide treatment 5. Thus, long-term treatment with octreotide did not afford protection against the development of renal hypertrophy-hyperfiltration and the evolution of early diabetic nephropathy in rats.

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Interaction of the endothelin system and calcineurin inhibitors after kidney transplantation

Clinical Science ◽

10.1042/cs103s396s ◽

2002 ◽

Vol 103 (s2002) ◽

pp. 396S-398S ◽

Cited By ~ 13

Author(s):

Torsten SLOWINSKI ◽

Thomas SUBKOWSKI ◽

Petra DIEHR ◽

Daniela BACHERT ◽

Lutz FRITSCHE ◽

...

Keyword(s):

Kidney Transplantation ◽

Calcineurin Inhibitors ◽

Urinary Protein Excretion ◽

Urinary Protein ◽

Converting Enzyme ◽

Protein Excretion ◽

Endothelin System ◽

Endothelin Converting Enzyme ◽

Group Time ◽

Morning Dosage

Plasma endothelin (ET)-1 concentrations have been shown to be elevated in patients receiving calcineurin-inhibitors (CI). We investigated urinary and plasma ET-1 (uET-1, pET-1), BigET-1 (uBigET-1, pBigET-1) concentrations, and plasma soluble endothelin-converting enzyme (ECE) concentrations in 381 adult caucasian kidney allograft recipients with graft survival of more than 2 years from the outpatients department of our clinic. Blood and urine probes were always drawn immediately before morning dosage of immunosuppressants. Mean of urinary protein excretion (meanProt) and mean of serum creatinine (meanCrea) were calculated from all available measurements in the most recent year. uET-1 and uBigET-1 were adjusted for urinary protein excretion by calculating uET-1/meanProt and uBigET-1/meanProt. Patients (n = 310) were on a cyclosporine A or FK506 (CI-group) based immunosuppression protocol, and 71 patients were immunosuppressed without use of CI (nonCI group). Time since transplantation was similar in both groups (mean±S.D.; CI-group: 7.55±2.50; nonCI-group: 7.74±3.06 years, P = 0.240) as well as meanCrea (mean±S.D.; CI-group: 1.97±1.34; nonCI-group: 1.77±1.29mg/dl, P = 0.326). pET-1 was significantly higher in the CI-group, compared with nonCI (mean±S.D.; 0.87±1.4 versus 0.56±0.76fmol/ml, P = 0.011). pBigET-1 was similar (mean±S.D.; 0.85±1.41 versus 0.70±1.21fmol/ml, P = 0.33). ECE concentrations were higher in the CI group (mean±S.D.; 14.30±18.02 versus 9.23±7.42ng/ml, P = 0.001). uET-1/meanProt and uBigET-1/meanProt concentration were similar in the CI-group compared with the nonCI-group (mean±S.D.; uET-1/meanProt: 15±24 versus 21±40pmol/g, P = 0.139; uBigET-1/meanProt: 34±55 versus 19±23pmol/g, P = 0.248). pET-1 elevation in patients receiving CI might be more likely to be due to elevated conversion of pBig-ET-1 by more ECE, and not to higher concentrations of pBigET-1.

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